Hyperthyroidism

Question 1

What is hyperthyroidism?

Answer 1

A condition in which the thyroid gland produces excess thyroid hormones

Question 2

What is thyrotoxicosis?

Answer 2

The clinical syndrome caused by excess circulating thyroid hormones, regardless of source

Question 3

How do hyperthyroidism and thyrotoxicosis differ?

Answer 3

Hyperthyroidism refers to gland overactivity, whereas thyrotoxicosis may occur without thyroid overproduction

Question 4

Which population is most commonly affected by hyperthyroidism?

Answer 4

Women and elderly patients

Question 5

What is the most common cause of hyperthyroidism?

Answer 5

Graves’ disease

Question 6

What autoimmune mechanism causes Graves’ disease?

Answer 6

TSH receptor–stimulating antibodies causing excess thyroid hormone production

Question 7

What are the main primary causes of hyperthyroidism?

Answer 7

Graves’ disease, toxic adenoma, toxic multinodular goitre, thyroiditis

Question 8

What is a toxic adenoma?

Answer 8

A single autonomously functioning thyroid nodule producing thyroid hormones

Question 9

What is toxic multinodular goitre?

Answer 9

Multiple autonomously functioning nodules producing thyroid hormones

Question 10

How does thyroiditis cause thyrotoxicosis?

Answer 10

Release of preformed thyroid hormone due to gland inflammation

Question 11

Which drugs can cause hyperthyroidism or thyrotoxicosis?

Answer 11

Amiodarone, lithium

Question 12

What rare pituitary cause can lead to hyperthyroidism?

Answer 12

TSH-secreting pituitary adenoma

Question 13

How can pregnancy-related hormones cause hyperthyroidism?

Answer 13

β-hCG can stimulate TSH receptors in gestational hyperthyroidism or choriocarcinoma

Question 14

What is struma ovarii?

Answer 14

Ectopic thyroid tissue in an ovarian tumour producing thyroid hormone

Question 15

What metabolic effect is characteristic of hyperthyroidism?

Answer 15

Increased basal metabolic rate

Question 16

What cardiovascular features are typical of hyperthyroidism?

Answer 16

Tachycardia, palpitations, atrial fibrillation, high-output heart failure

Question 17

What gastrointestinal symptoms occur in hyperthyroidism?

Answer 17

Weight loss, diarrhoea, increased appetite

Question 18

What thermoregulatory symptoms are common in hyperthyroidism?

Answer 18

Heat intolerance, sweating, warm skin

Question 19

What neuromuscular features are seen in hyperthyroidism?

Answer 19

Tremor, proximal muscle weakness, hyperreflexia

Question 20

What psychological or behavioural symptoms are common?

Answer 20

Anxiety, irritability, insomnia, restlessness

Question 21

What menstrual changes can occur in hyperthyroidism?

Answer 21

Oligomenorrhoea or amenorrhoea

Question 22

What eye signs are specific to Graves’ disease?

Answer 22

Exophthalmos, ophthalmoplegia, lid retraction

Question 23

What causes Graves’ ophthalmopathy?

Answer 23

Autoimmune inflammation of orbital tissues

Question 24

What is pretibial myxoedema?

Answer 24

Localised skin thickening and oedema over the shins seen in Graves’ disease

Question 25

What is thyroid acropachy?

Answer 25

Digital clubbing with soft tissue swelling and periosteal bone formation

Question 26

What is the typical TFT pattern in hyperthyroidism?

Answer 26

High FT4 and/or FT3 with suppressed TSH

Question 27

Which antibody supports a diagnosis of Graves’ disease?

Answer 27

TSH receptor antibodies (TRAb)

Question 28

What radioactive uptake pattern is seen in Graves’ disease?

Answer 28

Diffuse, homogenous increased uptake

Question 29

What uptake pattern suggests a toxic adenoma?

Answer 29

Focal increased uptake

Question 30

What uptake pattern is seen in thyroiditis?

Answer 30

Low uptake

Question 31

What is the first-line drug treatment for hyperthyroidism?

Answer 31

Antithyroid drugs such as carbimazole

Question 32

How do antithyroid drugs work?

Answer 32

Inhibit thyroid peroxidase, reducing thyroid hormone synthesis

Question 33

What serious adverse effect must be warned about with carbimazole?

Answer 33

Agranulocytosis

Question 34

Which symptoms suggest agranulocytosis?

Answer 34

Fever, sore throat, mouth ulcers

Question 35

Which antithyroid drug is preferred in the first trimester of pregnancy?

Answer 35

Propylthiouracil (PTU)

Question 36

Why are beta-blockers used in hyperthyroidism?

Answer 36

To control adrenergic symptoms such as tremor and tachycardia

Question 37

Which beta-blocker is commonly used?

Answer 37

Propranolol

Question 38

When is radioiodine therapy used?

Answer 38

Relapse after drug therapy or intolerance to antithyroid drugs

Question 39

What are contraindications to radioiodine therapy?

Answer 39

Pregnancy, breastfeeding, relative contraindication in active thyroid eye disease

Question 40

What is the most common long-term outcome after radioiodine?

Answer 40

Hypothyroidism requiring lifelong thyroxine

Question 41

When is surgery indicated in hyperthyroidism?

Answer 41

Large goitre, suspicion of malignancy, failed medical therapy, or compression symptoms

Question 42

Why must patients be euthyroid before thyroidectomy?

Answer 42

To reduce the risk of thyroid storm

Question 43

What is thyroid storm?

Answer 43

A life-threatening exacerbation of hyperthyroidism

Question 44

What are key clinical features of thyroid storm?

Answer 44

Fever, agitation, delirium, severe tachycardia, heart failure

Question 45

What drugs are used to block peripheral effects in thyroid storm?

Answer 45

IV propranolol and digoxin

Question 46

What drugs inhibit hormone synthesis in thyroid storm?

Answer 46

Propylthiouracil followed by iodine

Question 47

Why is iodine given after PTU in thyroid storm?

Answer 47

To block release of thyroid hormones

Question 48

What is the role of corticosteroids in thyroid storm?

Answer 48

Reduce peripheral conversion of T4 to T3 and treat adrenal stress

Question 49

What cardiac complication is most strongly associated with hyperthyroidism?

Answer 49

Atrial fibrillation

Question 50

How does hyperthyroidism affect bone health?

Answer 50

Increased bone resorption leading to osteopenia or osteoporosis

Question 51

What airway complication can occur with large goitres?

Answer 51

Upper airway obstruction